October 13, 2017

"President Donald Trump plans to cut off subsidy payments to insurers selling Obamacare coverage..."

Politico reports.
“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare,” [Press Secretary Sarah Huckabee Sanders] said. “In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments. …The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system.”...

While Republican lawmakers complained the subsidies were never properly appropriated by Congress, many were wary of ending them suddenly....

"It's time for Congress to fix this bill. That's what needs to happen. Congress has got to get together," [Attorney General Jeff Sessions] said. "Republicans and the Democrats, they've got to come on board and they've got to develop a plan that will actually work. It can not continue in this fashion. It's in a death spiral it seems to me."
Trump is carrying on the Obama tradition of doing everything in the Executive Branch. The complaints should be directed at Congress.

89 comments:

Michael K said...

This is a bullet to Congress' court. It might just be too hot for McCain to posture now.

Roy Jacobsen said...

If the payments were illegal--IANAL, and all that, but from a plain reading of things, it appears to me that they were--then Trump did the right thing.

Congress--and the GOP in particular--needs to get their poop in a group and deal with this fustercluck.

rhhardin said...

Cancel all Obama's executive orders regardless.

Dude1394 said...

Pretty amazing, trump FOLLOWS THE LAW and gets raked about it anyway.

It is great politics however imo. The democrats now can come to the table and do SOMETHING or nothing, their choice.

Drago said...

Michael K: "This is a bullet to Congress' court. It might just be too hot for McCain to posture now."

Nonsense.

McCain is in full "lifelong republican"-Dem defense mode.

He will be more than happy to thwart any and every initiative to undo obamacare...and deliver tax reform...and create real immigration reform that defends the US against the next wave of democrat voters.

David said...

"The complaints should be directed at Congress."

100% correct.

JayDee77 said...

At some point, the red state Dems will have to come to the table on both Obamacare and the tax cuts. The more pressure Trump applies, the sooner it happens.

Matthew Sablan said...

The consequences, they were unexpected!

Now I Know! said...

Trump and Republicans now own healthcare.

retail lawyer said...

"While Republican lawmakers complained the subsidies were never properly appropriated by Congress . . . "

I complained to all 3 of my female Federal lawmakers (Boxer, Feinstein, and Eshoo) about this exact point. I asked, "what is it you do there? This is your job. Object that someone is taking away your responsibilities". Of course, they all responded as if they did not understand the point, or did not read the email. To be fair, two of them are too poorly educated to understand the point. I guess I was hoping some staffer would eventually point out the problem . . .

Obama once said that people don't care about procedure. I do, and I found this very distressing.

Michael K said...

He will be more than happy to thwart any and every initiative to undo obamacare...and deliver tax reform...and create real immigration reform that defends the US against the next wave of democrat voters.

Oh, I agree. It's just that this is do or die. If the GOP Congress does nothing, Obamacare dies.
Beautiful strategic move by Trump.

Michael K said...

"Once..." does not understand that these two moves, the EO and the end to subsidies solves the problem for everyone but those living off Medicaid and those are all Democrats.

MaxedOutMama said...

It's not just an issue of Executive prerogatives - constitutionally speaking, the lawsuit against these payments had merit. That's why it has not been thrown out.

If Congress wants these payments made, Congress should appropriate for them. That is up to Congress. Congress (and this refers to both GOP & Dems) needs to step up to the plate on a number of matters and start fulfilling its constitutional responsibilities. Puerto Rico is one of them.

One could sharply criticize Trump for continuing these payments. Certainly he will be criticized for halting them. If there must be criticism, were I in his place, I would want to be in a legal position rather than an extralegal position.

Original Mike said...

"the Government cannot lawfully make the cost-sharing reduction payments."

Will be entertaining watching the left argue the other side of this. "Laws? We don't need no stinkin' laws."

Now I Know! said...

The only way Trump can make it work given these actions is to get rid of the preexisting conditions mandate. Let's see how that goes over politically.

Matthew Sablan said...

"Trump and Republicans now own healthcare."

-- Based on what? Enforcing the law as written and approved by Obama and the Democrats? #ItsTheLaw

Should've maybe asked Republicans for some input, since we were saying this since day two or three of the law's unveiling. You don't get to say someone else owns your screw up.

Original Mike said...

"Trump and Republicans now own healthcare."

It speaks volumes that the left, which sings the praises of ObamaCare, wants to unload the blame on someone else.

retail lawyer said...

Now I know is finally correct. Republicans do own health care. They won the elections, and they altered the regime. They tried, but now they are in blow it all up mode.

The problem for them is that brinksmanship is being played with something very important to actual real people with real budgets . . . .

Matthew Sablan said...

Retail Lawyer: The Republicans didn't blow up the ACA. The Democrats sucked at crafting the legislation, and these are the expected consequences of bad legislation.

Matthew Sablan said...

Now, I doubt the Republicans will come up with a good fix, but the fact Democrats screwed up the ACA isn't the fault of the people who were literally locked out of the room while the law was drafted.

donald said...

Lets do.

Big Mike said...

I keep getting urgent letters from my Congresswoman about how Democrats have targeted our district and how much she needs money to prevent a Democrat takeover. But aside from voting for Ryan for Speaker (vice the dementia-suffering Pelosi) I'd be hard pressed to find any vote she's taken that would be different from what a generic Democrat would have voted for.

I guess she's not sure what "work" means.

Original Mike said...

Seems like he should have done this before the reconciliation deadline to force the Republicans to pass a bill.

Matthew Sablan said...

(Frankly, the whole thing should've been killed a long time, but only Obama refusing to follow the law as written, but proud to state #ItsTheLaw, decided that no one would ever enforce the law as written and, instead, join him in the fiction that it was a well constructed law. Then Trump won.)

Khesanh 0802 said...

This is GREAT!!!! Now get Congress off their special health insurance teat!

EDH said...

Is this $7 billion in direct subsidies to premium payers (i.e., ear marked dollar for dollar to reduce individual premiums), to the insurers generally simply for their "participation" with trickle-down to rate payers, or as "risk corridors" to insurers for taking on specific policyholders with pre-existing conditions?

Horribly written article from Politico.

Big Mike said...

@Matthew Sablan, they didn't just suck at crafting the legislation, Kathleen Sebelius and her minions totally screwed up the implementation.

Big Mike said...

Now Trump needs to write an EO putting Congress on Obamacare. Not a surprise that they exempted themselves from it; they may not be the sharpest tacks in the bulletin board, but they know a disaster when they see it.

bgates said...

Trump is carrying on the Obama tradition

Not here he's not. There has never been a need for a President to continue the illegal activity of his predecessor until Congress tells him he's allowed to stop.

dreams said...

"Trump and Republicans now own healthcare."

And you'll be the first to give them credit for improving health insurance?

Michael K said...

"The only way Trump can make it work given these actions is to get rid of the preexisting conditions mandate. Let's see how that goes over politically."

Pre-existing conditions needs to be on Medicaid and part of the block grant to states.

This was dealt with before by risk pooled funds by states.

It might even turn the attention of the "pre-existing conditions" lobby to the governors which is where it should be,

Expat(ish) said...

Not even vaguely tired of winning.

Nope.

_XC

Original Mike said...

"Obama once said that people don't care about procedure. I do, and I found this very distressing."

Me too. Another word for "procedure" is "lawfulness". Obama's behavior boggles my mind.

Martin said...

Seems to me this is reversing the "Obama tradition," NOT carrying it in.

Obama saw the lack of an appropriation and took it upon himself to authorize spending, in essence saying, "Congress didn't appropriate these funds that I want to spend, so I will go over their Constitutional heads and spend it as I wish despite lack of appropriation."

Trump is saying, "No, we will follow the law and the Constitution. If Congress wants to spend this money for this purpose, they must appropriate it. I am not going to keep spending in the absence of appropriation just because my predecessor did."

For all the bloviating, Trump's actions have been far more law-abiding than Obama's in a range of areas. Trump talks a big game sometimes, but has been respectful even of court decisions that go against him and are on their face ridiculous and politically motivated--the E.O.s on visas a good case in point.

Ignorance is Bliss said...

Trump is carrying on the Obama tradition of doing everything in the Executive Branch.

That is certainly true in other cases. However, in this case, Trump is stopping doing something in the Executive Branch, because the Constitution says he can't do that without authorization from the Legislative Branch, which he does not have.

An the issue with President Obama was never that he did things in the Executive Branch. It was that he did things in the Executive Branch that were not within the powers granted to the President by the Constitution.

lgv said...

I watched the CNN feed (without sound) at the gym this morning. The meme is "Trump ending insurance subsidies". This is designed to make people believe that the subsidies were the ones given to the buyers, not the ones given to the insurance companies.

The subsidies to insurance companies (or corporate welfare if you prefer) were sold to us on the reasonable rationale that the insurance companies had no idea what the proper pricing was on the new plans and that they need their insurance in order to join the Obamacare program. That rationalization means there would an expiration date on the subsidies anyway. I believe it was going to be 3 years, but the bottom line is that insurance companies would adjust the prices of the plans accordingly and wouldn't need subsidies at some point.

That point is now. Good. The public needs to see the real cost of Obamacare plans, not the back door subsidized cost provided by protected insurance companies.

Rick said...

Now I Know! said...
Trump and Republicans now own healthcare.


The far left comes out in favor of corporate welfare. We always knew their opposition was theater but do you suppose any of those currently engaging in it will realize?

exiledonmainstreet said...

"McCain is in full "lifelong republican"-Dem defense mode."

Good God, do I regret my vote for him in 2008. I now think he might have been worse for the country than Obama was; a GOPe president taking every opportunity to "reach across the aisle" would have demoralized the conservative base far more than Obama did.

Matthew Sablan said...

"@Matthew Sablan, they didn't just suck at crafting the legislation, Kathleen Sebelius and her minions totally screwed up the implementation."

-- This is true. We should embrace the healing power of "and."

Matthew Sablan said...

I'm always surprised at McCain, because I took a different message from the Obama campaign. Whereas McCain held to his promises, even spending some money to congratulate Obama for his primary win and refusing to touch Obama on issues like Rev. Wright... Obama made fun of McCain's injuries received during his stint as a POW and the Democrats publicly claimed to need McCain back in Congress, then once he came back, went on TV to say that he was being erratic and senile.

I took away from this that compromise was not going to happen with national level Democrats until they had a good electoral purge of their less savory leadership.

McCain took it that "Republicans need to try harder to reach across the line!"

Earnest Prole said...

Trump is carrying on the Obama tradition of doing everything in the Executive Branch. The complaints should be directed at Congress.

After fifty years of the media making the American president out to be some kind of king, even Republicans are unaware that laws are made by Congress and not by decree.

rehajm said...

From the standpoint of the consumer Trump has provided a pathway for insurers to offer differentiated products then pulled the cost subsidy for all-you-can-eat policies. Insurers may step in with a variety of products and create a viable risk pool, which they didn't have under the Obama rules. No way is it perfection but let's see what happens before we call the time of death on the whole thing. It's amazing what can happen when enough of the proper incentives are in place.

Rusty said...

Now I Know! said...
"Trump and Republicans now own healthcare."

Read carefully. You dunderheads still own it. Trump is trying to make it more affordable for ALL Americans. Something not based on the outright lies of the ACA. Get it?

Yancey Ward said...

Like a few commenters above, this particular EO is firmly grounded in the law telling the executive what he cannot do. This is qualitatively different from almost all of Obama's contentious EOs. I think it an open and shut case that these particular subsidies were not properly funded by Congress, and thus the executive branch cannot expend the funds on them. If Congress doesn't like this, it can easily put a bill on Trump's desk giving them a proper appropriation- at that point, the Left can properly criticize Trump for undermining the ACA if he vetoes it.

Drago said...

Rick: "The far left comes out in favor of corporate welfare"

The lefties are also now in full favor of helping businesses get cheap foreign labor and crushing the ability of US citizens in the lower economic segments to increase their earnings and improve their quality of life.

This is the modern left.

Whatever the cabal of high tech/establishment/dems/"lifelong republicans" want.

James K said...

"brinksmanship is being played with something very important to actual real people with real budgets . . . "

Brinksmanship involves two sides. Surely the party that has voted overwhelmingly to block any legislative efforts in health insurance reform should be held responsible. Not to mentioned the ones that inflicted the disastrous ACA on us in the first place through legislative manipulation. That would be the Democrats.

Yancey Ward said...

The problem with the ACA, and the reason it is is going to collapse is that it those who benefit from it were only partially funded by appropriations from Congress- a great deal of the funding comes from forcing people to buy a product they don't need, or forcing them to overpay for such a product. However, the penalties that enforce the purchase of this unwanted product simply don't work- the people largely still don't buy it, so the funding that was expected isn't there supporting it, so the insurers end up either eating the losses, or they drop out of the market. Something will have to be done- even if Trump had continued to illegally fund this particular provision, the exchanges were still going to fail, this only moves that date forward by a year or two.

Ignorance is Bliss said...

lgv said...

The subsidies to insurance companies (or corporate welfare if you prefer) were sold to us on the reasonable rationale that the insurance companies had no idea what the proper pricing was on the new plans and that they need their insurance in order to join the Obamacare program.

Igv-

I believe you are incorrect. The risk corridors were a separate program. This one is not about the rates that insurance companies set in general. It is about insurance companies being required to sell insurance to low-income people below cost, for which the government would reimburse them. They are still required to sell at that below cost rate, but now will not get reimbursed. ( They have the right to pull out of the market if the subsidies stop. If they stay in, they must sell at the government set rate to low-income buyers. )

Rae said...

If the payments were really illegal, the government should demand the money back.

(But have no fear, I am sure the congress will pass an appropriation for this within a week. One thing both sides can get together on is treating the taxpayers like actresses on Weinsteins couch)

Khesanh 0802 said...

Risk corridor funds were supposed to come from insurance companies that made too much money paying those who lost money. There was no provision for the Federal government to make payments and when Congress refused to appropriate the funds the courts finally said that the Federal government had no authority to make them. Both Obama and Trump continued to authorize illegal payments until today. I see that others have made the same essential comment so I must be right!


"A federal judge in 2016 ruled the cost-sharing payments were improper after House Republicans filed a lawsuit in 2014 to block them, arguing that they hadn’t been approved by Congress as necessary. The case has been in a holding pattern, with regular updates to the court every three months." WSJ 10/13/17

Todd said...

Now I Know! said...

The only way Trump can make it work given these actions is to get rid of the preexisting conditions mandate. Let's see how that goes over politically.

10/13/17, 11:25 AM


Funny but if I recall correctly "it" is not Trump's to make work. He has to do nothing. It "was" the Obama Congress's responsibility to make it work and they failed spectacularly as that was the point. Their expectations were that this steaming pile would be enacted under Obama and single-payer would be enacted either by Obama or Hillary. Fortunately that did not work out.

Sebastian said...

"Trump is carrying on the Obama tradition of doing everything in the Executive Branch" Not quite. As others have noted or implied, Trump is using executive action to undo blatantly illegal prior executive action.

tim in vermont said...

Now I Know wants Trump to have dictatorial powers. The ability to spend money without Congressional authorization.

Michael K said...

It's int3resting that Rand Paul has now come out in favor of Trump's two actions and says he designed some of this policy.

Jupiter said...

Blogger Now I Know! said...
"The only way Trump can make it work given these actions is to get rid of the preexisting conditions mandate. Let's see how that goes over politically."

Now, I think you'd better tell HQ that you aren't up for this gig. They need to at least send someone from the B Team. Trump can't, and needn't, get rid of the pre-existing condition mandate. What Trump has gotten rid of is the individual mandate, by telling the IRS not to enforce the "tax". And politically, that is a huge winner.

Of course, the insurance companies that went along with Obama 'cause he said he'd take care of them must be feeling kind of screwed. Lie down with dogs ...

Matthew Sablan said...

"If the payments were really illegal, the government should demand the money back."

-- I don't think they can do that. The government screwed up, not the companies. It would be wrong to punish them retroactively like that.

Matthew Sablan said...

"Trump can't, and needn't, get rid of the pre-existing condition mandate."

-- Why would he get rid of something that Republicans offered Democrats as a stand-alone bill so it didn't get held hostage by the ACA?

MaxedOutMama said...

lgv & Ignorance Is Bliss These are the COST-SHARING subsidies. Not the subsidies for premiums, which are still intact. And not the risk corridor premiums.

The cost-sharing subsidies are payments made to insurance companies to compensate for the fact that they are not allowed to impose the full deductibles or full copays on individuals who bought qualifying plans through the exchanges with incomes below 250% of the poverty line. You have to be pretty low-income to qualify, but because it is a first-dollar expense to the insurance companies it does leave them in an awkward position. The insurance companies have to cover the cost up front.

Basically, the Silver plans expect that on average, an insured will cover 30% of their own medical costs. The cost-sharing cuts that to 27% for 200-250%, 13% for 150-200%, and 6% for 100-150%.

This is in court. I believe the current status is that there are about a million parties to the case on appeal and that a judge is currently dealing with the whole mess, but the whole thing is sort on hold, at the request of the Trump admin. Last year Collyer ruled that there was no authority to make these payments without an appropriation, but stayed it:
http://healthaffairs.org/blog/2016/05/12/judge-blocks-reimbursement-of-insurers-for-aca-cost-sharing-reduction-payments/

It was appealed. House v Burwell, DC District Court.

Diogenes of Sinope said...

Follow the ACA as written.

Matthew Sablan said...

"Follow the ACA as written."

-- The surest way to change a bad rule is rigorous enforcement.

dreams said...

"It's int3resting that Rand Paul has now come out in favor of Trump's two actions and says he designed some of this policy."

And he is correct, he's been saying on Facebook that Trump would do this and that he was helping with the plan.

Hammond X. Gritzkofe said...

Great God! The President has taken upon himself to abide by the Law!

Can orders of impeachment be far behind?

lgv said...

Ignorance is Bliss

Igv-

I believe you are incorrect. The risk corridors were a separate program. This one is not about the rates that insurance companies set in general. It is about insurance companies being required to sell insurance to low-income people below cost, for which the government would reimburse them. They are still required to sell at that below cost rate, but now will not get reimbursed. ( They have the right to pull out of the market if the subsidies stop. If they stay in, they must sell at the government set rate to low-income buyers. )



Thank you for the clarification/correction. This is even better. This will clearly demonstrate the ACA is a complete failure on its own. It cannot continue without overt action by Congress of throwing money at it. Lot's of money.

Rabel said...
This comment has been removed by the author.
Rabel said...

This has been adjudicated and Judge Collyer didn't leave a lot of wiggle room.

"The Affordable Care Act unambiguously appropriates money for Section 1401 premium tax credits but not for Section 1402 reimbursements to insurers. Such an appropriation cannot be inferred. None of Secretaries’ extra-textual arguments—whether based on economics, “unintended” results, or legislative history—is persuasive. The Court will enter judgment in favor of the House of Representatives and enjoin the use of unappropriated monies to fund reimbursements due to insurers under Section 1402. The Court will stay its injunction, however, pending appeal by either or both parties."

By the way, Collyer is the lead judge on the secret FISA court. I wouldn't fuck with her.

- Edited to correct the mess I made.

n.n said...

Perhaps we should consider another perspective. With Obama successfully doubling the public debt, forcing excessive immigration, and suppressing scrutiny of elective wars and collateral damage (e.g. CAIR), is there cause to subsidize, let alone penalize, people to pay for medical care?

For everyone a beachfront estate in Hawaii, and a beachfront estate in Hawaii to everyone, right?

You can have your baby and abort her, too.

John Pickering said...

Trump is carrying on the Obama tradition of doing everything in the Executive Branch. The complaints should be directed at Congress.

Obamacare was, of course, passed by Congress. The Iran deal was approved by Congress. The financial company bailouts, approved by Congress. Please try to be more exact in your prose, insofar as you have readers who might take you seriously.

Original Mike said...

"Obamacare was, of course, passed by Congress."

Though not the payments in question.

Original Mike said...

"The Iran deal was approved by Congress."

Forgive my ignorance, but I thought Obama didn't submit "The Deal" to Congress.

Original Mike said...

". The financial company bailouts, approved by Congress."

Sadly, yes.

gadfly said...

@Now I Know! said...
Trump and Republicans now own healthcare.

Now that is asinine! Obamacare was designed, organized and passed by Democrats (without a single line of input nor vote by the GOP) and loopholes were inserted by the the Democrat administrations (some legally, many others not so legal) to achieve liberal love, thus perpetrating costly new "benefits" by the party-in-charge. $2,500 premium deductions easily became $7,500 increases for many middle class families when the dust settled.

There was no authorization for sending subsidy payments to insurance companies but the prior administration did in the case of Obamacare. Too many regions of the country are without medical insurance providers and not even the fastest negotiations can put new plans in place immediately with this course correction.

Trump followed some good advice but his timing was shitty - as usual.

Amadeus 48 said...

The GOP's greatest fear has come upon them: they will actually have to take responsibility for fixing the dog's breakfast that is Obamacare.

alan markus said...

To all you people engaging with Now I Know "Trump and Republicans now own healthcare"

You are arguing with a headline - Google the quote and you will see that has been the headline for quite a few articles and opinion pieces.

Certainly not something that was ideated in Now I Know's head. He/she has yet to post an original thought - at least Ann cut off the autistic like repetition about the number of posts devoted to Weinstein.

Drago said...

Lol

Gadfly...the poor man's "Chuck"

Matthew Sablan said...

"You are arguing with a headline - Google the quote and you will see that has been the headline for quite a few articles and opinion pieces."

-- Wonderful. A new meme to have to learn to grit my teeth through.

Drago said...

The Iran deal was approved by Congress

Wrong.

Dems filibustered so no vote was taken.

Jim at said...

"The Iran deal was approved by Congress."

This is news to me.

Link, please.

PackerBronco said...

Blogger Matthew Sablan said...
"Follow the ACA as written."

-- The surest way to change a bad rule is rigorous enforcement.


I'm open to compromise on this topic. Let's enforce it exactly as written only in the Blue states.

PackerBronco said...

Blogger Todd said...

Funny but if I recall correctly "it" is not Trump's to make work.


I believe that principle, as set down by Judge "It's a Tax!" Roberts is that the ACA can only be interpreted in such a way as it make it work.

PackerBronco said...

Blogger Now I Know! said...
Trump and Republicans now own healthcare.


Being liberal means never having to say: "I'm responsible"

PackerBronco said...

Saying the republicans are responsible is like saying the EMTs are responsible for the road accident.

tim in vermont said...

Treaties are supposed to be approved by the Senate. Had Obama done that, it would have been difficult to rescind it, but the American people would then learn what's in it, so that was a non starter.

The Godfather said...

My only source of network news is Good Morning America (ABC). This morning they headlined Trump killing medical care for millions of people who couldn't afford it. If they said anything about these payments not having been legally appropriated by Congress, I must have missed it. If they said anything substantive about Trump ordering rule-makings to make Obamacare more flexible, that was lost in the din about all the poor folks who will die because of Trump. I learn a great deal from intelligent commenters on Althouse, as well as from various other reasonable websites. But I fear an awful lot of people still wait with bated breath to hear what Walter Cronkite says.

Original Mike said...

"My only source of network news is Good Morning America (ABC)."

Perhaps that's John Pickering's situation as well.

Michael K said...

"My only source of network news is Good Morning America (ABC)."

Is that still on TV ?

Good to know.

Narayanan Subramanian said...

Claw back $$$$$ .... Whyever not ... Is this high crime misdemeanors?

The Cracker Emcee Activist said...

"Claw back $$$$$ .... Whyever not ... Is this high crime misdemeanors?"

Incoherent, clueless, and desperate is no way to go through life, son.

Etienne said...
This comment has been removed by the author.
jaed said...

1. I am here way too late, so no one will read this.

2. Nevertheless, I will do an explainer comment.

3. As someone said above, these are cost-sharing subsidies, not risk corridors or premium subsidies. People with incomes below 250% of poverty level, if they buy insurance on the exchange, get a break on the deductible, coinsurance, copays, and out-of-pocket maximum; insurance companies are required to provide this. The cost-sharing subsidies pay them back for providing this benefit to this group of people.

4. This is separate from the premium subsidies. Everyone with cost-sharing subsidies is eligible for a lower, subsidized premium, but not vice versa.

5. People who buy individual insurance not on the exchange, and people who make over 400% of poverty level, are eligible for none of this.

6. The insurance companies are still obligated by law to provide the cost-sharing subsidies, even though they won't be getting paid back for them by the federal government any more.

7. Because of that, they will raise premiums even more on their individual policies, over and above the huge premium increases due to the ACA.

8. Since the insurance companies must still provide the cost-sharing subsidies whether they get paid back for them or not, people below 250% of poverty level will still get these breaks. They won't see a difference.

9. People who get subsidized premiums (buy on the exchange + income under 400% of poverty level) will get an increased premium subsidy to make up for the increased premium amount, so they won't see a difference either.

10. People who buy on the individual market and whose incomes are even a little more than 400% of poverty level will take it in the shorts. Their premiums will increase even faster than they were already, and they are not eligible for any of these subsidies.

10. That's assuming the companies don't give up on the individual market entirely and exit, leaving no one to buy insurance from even if you could afford the premiums.

11. The end.